6. Referral, medical risk, and what BSP published after Stage I–III
When GDP should not finish the story alone
Complexity (Grade C, surgery, combined restorative-perio plans, non-plaque-induced disease, Stage IV rehabilitation, peri-implantitis) sits in BSP referral thinking and in NHS restorative commissioning levels. Initial care still belongs in primary care for most periodontitis — refer after a genuine Step 1–2 attempt unless the presentation is clearly beyond that (for example aggressive destruction in a young person, or a medical diagnosis you cannot establish).
Write a referral a specialist can use
Diagnosis (stage, grade, extent, status), BPE/charts, radiographs, smoking, diabetes, what Step 1–2 you did, plaque and bleeding scores, and whether the person is engaging. “Please see for perio” is not a letter.
Diabetes
Hyperglycaemia worsens periodontal destruction and healing. Ask about control, explain the two-way conversation, treat the periodontitis, and write to the medical team when it will change care. Do not delay Step 1 waiting for a perfect HbA1c.
Stage IV and implants — later BSP S3 work
After the Stage I–III treatment guideline, BSP adapted further EFP S3 work on Stage IV (rehabilitating people with severe attachment loss and functional problems) and on prevention and treatment of peri-implant mucositis and peri-implantitis. Those are not “a deeper scale”. If the patient has implants or a collapsing occlusion from periodontitis, use those current BSP UK papers — this 2-hour course will not pretend to replace them.
Team
Hygienists and therapists deliver much of Steps 1, 2 and 4 within their scope. Dentists own diagnosis, the medical-risk conversation, prescription decisions, and when to refer. Nurses make the pathway real: time, charts, smoking status, and not calling Step 4 a “scale and polish” on the day list.
Always follow current BSP S3 flowcharts, BPE guidance, referral documents, and Delivering Better Oral Health. This course is original teaching for CPD, not legal or commissioning advice.